Atrial fibrillation and frailty: An observational cohort study using electronic healthcare records

Atrial fibrillation is common in older people, and is associated with increased mortality and stroke. Patients with atrial fibrillation/flutter (AF) also commonly have frailty, which is associated with increased risk of a range of further adverse clinical outcomes. However, there is a lack of evidence on the burden and management of AF in people with frailty. A study using the primary care electronic health records of 536,955 patients aged ≥65 years was conducted to investigate the burden of frailty and AF amongst older people, and their associations with clinical outcomes. A systematic review and meta-analysis was completed to establish the current knowledge base, and to inform the quantitative analyses. Baseline characteristics were described and compared between those with and without AF as well as by frailty category according to the electronic frailty index. Rates of all-cause mortality, stroke, bleeding (intracranial and gastrointestinal), transient ischaemic attack (TIA), and falls were calculated per 1000 person-years, and compared with the non-AF patient population. Cox proportional hazards modelling was used to determine unadjusted and adjusted risk for each clinical outcome and mortality, and presented as hazard ratios (HR) alongside 95% confidence intervals. The association between oral anticoagulation (OAC) prescription stratified by frailty category with clinical outcomes was investigated using Cox proportional hazards modelling. At baseline, 61,177 (11.4%) patients had AF. People with AF had a higher burden of frailty than those without (89.5% vs. 55.3%) and had higher rates of mortality, stroke, TIA and bleeding. Of patients with AF and eligible for OAC, it was prescribed in 53.1% (41.7% in robust, mild frailty 53.2%, moderate 55.6%, severe 53.4%). OAC was associated with a 19% reduction in all-cause mortality (HR 0.81, 95%CI 0.77-0.85) and 22% reduction in stroke (HR 0.78, 0.67-0.92). There was no statistically significant difference in rates of bleeding between those prescribed and not prescribed OAC. For the first time in a large representative cohort of older people, this study quantified the burden of AF and frailty, and their association with a range of clinical outcomes. This study found no evidence that OAC should be withheld on the basis of concomitant frailty

Augmented reality for the real world

Los Alamitos, US

A Nurse\u27s Journey with Cultural Humility: Acknowledging Personal and Professional Unintentional Indigenous-specific Racism

This is a first-person reflection of my journey through cultural humility to identify a connection between my inherent beliefs about Indigenous Peoples and Indigenous-specific systemic racism. The co-authors of this paper provided guidance, mentorship, and support in organizing the framework due to the challenging and sensitive nature of the content. As part of my relational practice, I worked with a Cree scholar to write this paper. As a descendant of white European colonial settlers, I grew up in a small community in western Canada populated by people of similar backgrounds. My exposure to Indigenous Peoples and culture was very minimal; however, conversations and attitudes about Indigenous Peoples generally centered around negative and racist stereotypes. Childhood games and jokes insidiously contributed to the construction of my worldview by dehumanizing, belittling, and humiliating Indigenous Peoples. A necessary part of my journey was to recognize how these words and attitudes have informed my worldview and at the same time hurt Indigenous Peoples. Historical facts of Indigenous treatment were brushed off or minimized as something that happened in the past. Although sharing my experience is uncomfortable, I am compelled to identify and acknowledge how the deep-rooted beliefs and attitudes that I have towards Indigenous Peoples have been shaped by my education, culture, and experiences. I hope that my own developing journey with cultural humility may serve as a guide to deconstructing the historical, personal, and professional ways in which Indigenous-specific racism exists and is perpetuated in health care. My own first steps are an open invitation for the nursing profession to similarly begin to address unintentional and intentional racism in healthcare. By understanding Canadian history, committing to allyship, advocating for social justice, actively intervening by speaking up, and integrating trauma-informed care/principles into our practice, we may begin to effectively address Indigenous-specific racism in health care. Résumé Il s’agit d’une réflexion personnelle sur mon parcours en matière d’humilité culturelle afin d’identifier le lien entre mes croyances inhérentes au sujet des peuples autochtones et du racisme systémique dont ils sont victimes. Les coauteures de cet article ont fourni des conseils, de l’encadrement et du soutien pour développer le contexte en raison de la nature délicate du contenu. Dans le cadre de ma pratique relationnelle, j’ai rédigé cet article en collaboration avec un universitaire crie. Je suis descendante de colons européens blancs, j’ai grandi dans une petite communauté de l’ouest du Canada entourée de personnes aux origines similaires. J’ai été très peu exposée aux Autochtones et à leur culture, toutefois, les conversations et les mentalités les concernant étaient habituellement négatives et racistes. Les jeux et les blagues de mon enfance ont influencé ma conception du monde en déshumanisant, rabaissant et humiliant les peuples autochtones. Une des étapes cruciales de mon cheminement a été de reconnaître la façon dont ces mots et ces mentalités ont influencé ma perception du monde et par la même occasion, ont blessé les Autochtones. Les faits historiques et les traitements qui leur étaient réservés ont été balayés du revers de la main ou atténués en raison de leur nature ancienne. Bien que je sois mal à l’aise de vous raconter mon expérience, je me vois obligée d’identifier et de reconnaître que mes croyances et mes mentalités profondément enracinées envers les Autochtones ont été façonnées par mon éducation, ma culture et mes expériences. Je souhaite que mon cheminement vers l’humilité culturelle puisse servir de guide afin de déconstruire le racisme systémique envers les Autochtones présent dans les sphères personnelles, professionnelles et historiques et que cela se reflète dans les soins de santé. Cette première étape, bien que personnelle, constitue une invitation à la profession infirmière à s’investir dans la lutte contre le racisme volontaire ou involontaire dans les soins de santé. En comprenant l’histoire canadienne, en nous engageant à nous allier, en plaidant pour la justice sociale, en prenant la parole activement et en intégrant des soins et des principes qui tiennent compte des traumatismes dans notre pratique, nous pouvons commencer à lutter efficacement contre le racisme systémique envers les Autochtones dans les soins de santé

Addressing Indigenous-Specific Racism in Healthcare as Part of Reconciliation: A Nurses Responsibility to Mitigate Racism in Healthcare

Background: Reports of racism and discrimination, particularly Indigenous-specific racism within the Canadian health care system, has become common in the news. The November 2020 report entitled In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B. C. Health Care and the September 2020 death of Joyce Echaquan clearly indicate immediate action is required by all nurses to address current practice and to be accountable for delivering safe, competent, and ethical care to Indigenous peoples (First Nations, Métis, and Inuit). As a registered nurse and a white settler mother of two Indigenous sons, I cannot ignore Indigenous-specific racism. In alignment with the Truth and Reconciliation recommendations, I recognize the necessity to address the truth - the history of colonization in Canada and how it has affected and continues to affect Indigenous health and wellness. There are numerous publications that have described the legacy of both residential schools and the Indian hospitals, along with numerous anecdotal stories of the deplorable care provided to the First Peoples of Canada. This historical relationship has resulted in Indigenous peoples feeling deep mistrust towards the healthcare system. This sociopolitical history directly affects my Indigenous sons and their personal wellness as they navigate growing up in an environment of racism. Purpose: The purpose of this paper is to share with healthcare professionals the effects Indigenous-specific racism has on Canadian Indigenous people with the hope of fostering more authentic conversations to guide policy change and create an environment for safe, competent, compassionate, and ethical healthcare delivery. Implications: It is necessary for all health care providers to engage in safe, compassionate, competent, and ethical care for all patients. Practicing cultural safety an important first step when engaging with Indigenous peoples. This colonial history impacts my sons’ wellness and I have prepared a letter to share with them and my nursing colleagues. My hope is twofold: 1) that they will keep this letter and read it as they face unnecessary challenges simply because they are Indigenous; and secondly, the nursing profession will address and eliminate Indigenous-specific racism in healthcare.&nbsp

Micromanipulation of InP lasers with optoelectronic tweezers for integration on a photonic platform

The integration of light sources on a photonic platform is a key aspect of the fabrication of self-contained photonic circuits with a small footprint that does not have a definitive solution yet. Several approaches are being actively researched for this purpose. In this work we propose optoelectronic tweezers for the manipulation and integration of light sources on a photonic platform and report the positional and angular accuracy of the micromanipulation of standard Fabry-Pérot InP semiconductor laser die. These lasers are over three orders of magnitude bigger in volume than any previously assembled with optofluidic techniques and the fact that they are industry standard lasers makes them significantly more useful than previously assembled microdisk lasers. We measure the accuracy to be 2.5 ± 1.4 µm and 1.4 ± 0.4° and conclude that optoelectronic tweezers are a promising technique for the micromanipulation and integration of optoelectronic components in general and semiconductor lasers in particular

Characterisation of the bacterial flora associated with the grey field slug Deroceras reticulatum and assessment of its suitability as a target for biological control

The field slug Deroceras reticulatum is a major pest in UK agriculture and amidst growing concern and regulatory pressures surrounding chemical molluscicides, innovation is required to advance the current repertoire of slug controls. This study set out to investigate the bacteria associated with D. reticulatum to assess their importance to the slug and potential as a target for biological control. Slug gut bacterial isolates identified using the phenotypical API system (BioMérieux) and 16S rRNA gene sequencing, were mainly soil-dwelling organisms of the phyla Proteobacteria and Bacteriodetes some of which may be important in human or plant disease. A ribosomal intergenic spacer analysis (RISA) was developed to study microbial communities in the slug gut. Slugs had an average species richness of 12 and comparing the bacterial communities in slugs from different locations yielded a mean similarity of 0.159 (Jaccard index) which was significantly lower than similarity indices of slugs collected within a single location (Mean Jaccard index 0.205, p<0.001, ANOVA). Cloning and sequencing of RISA bands common to slugs and slug eggs, but absent from the surrounding soil and plants identified bacteria for future investigation as potential beneficial symbionts. Bacteria extracted from the slug gut were tested for sensitivity to 16 antibiotics and greatest inhibition of growth was observed for chloramphenicol, gentamicin and tetracycline. These antibiotics administered to slugs by feeding and injection caused a reduction in gut-associated bacteria in plate counts, and in bacterial 16S rDNA quantities estimated by real-time quantitative PCR. Field collected D. reticulatum has a large transient gut bacterial population which is reduced upon starvation to a low background level. No significant detrimental effect of antibiotic treatment on the fitness and survival of the slugs was seen, in some instances control slugs suffered greater mortality than slugs that had been injected with antibiotic. Slugs that died during bioassays had a significantly greater amount of bacterial 16S rDNA in their gut than slugs that were sacrificed as healthy individuals suggesting the presence of a bacterial pathogen. This study has found little evidence that a bacterial symbiont may exist and be important for optimal fitness and survival of D. reticulatum, but insight into slug associated bacteria will be valuable in the direction of future studies in this field

Time, timing, talking and training : findings from an exploratory action research study to improve quality of end of life care for minority ethnic kidney patients

Background. With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. Aim. This study purposively explored South Asian patients' experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Methods. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women). Emergent themes from the focus groups were analysed thematically. The research took place at four UK centres providing kidney care to diverse populations: West London, Luton, Leicester and Bradford. Results. Key themes related to time and the timing of discussions about end of life care and the factors that place limitations on patients and providers in talking about end of life care. Lack of time and confidence of nurses in areas of kidney care, individual attitudes and workforce composition influence whether and how patients have access to end of life care through kidney services. Conclusion. Training, team work and time to discuss overarching issues (including timing and communication about end of life) with colleagues could support service providers to facilitate access and delivery of end of life care to this group of patients.Peer reviewedFinal Published versio

"Alguien que me vigile": vigilancia, disciplina y el proceso laboral justo a tiempo

Se emplean la teoría y las observaciones para argumentar que los regímenes Justo a Tiempo (JAT)/Control Total de Calidad (CTC) crean y requieren sistemas de vigilancia, los cuales presentan mejoras respecto a regímenes previos al infundir disciplina, y por tanto, aumentar el control central. Dada su orientación teórica, este escrito se basa en el trabajo de Michel Foucault, especialmente en su concepción de poder/conocimiento, tal como se plantea en su libro Disciplina y castigo. Este soporte teórico se extiende para proporcionar un medio de análisis de los mecanismos de vigilancia y control que operan en el lugar de trabajo contemporáneo. Mientras se entiende que la responsabilidad táctica en una organización que practica el JAT/CTC es delegada, simultáneamente el control estratégico se centraliza; ésto representa una forma de degeneración. Basándonos en el trabajo de Foucault, argumentaremos que el enfoque JA T/CTC se facilita y se acentúa mediante la operación de dos fuerzas disciplinarias complementarias. La primera de ellas es la disciplina que se deriva del escrutinio de los propios compañeros en una celda de manufactura, círculo de calidad, etc., un proceso horizontal que es sustentado por la estructura organizacional asociada con los procesos JAT/CTC. La segunda fuerza disciplinaria clave es aquella que se deriva del uso de los cada vez más poderosos sistemas de información administrativos, los cuales suministran vigilancia extensiva a nivel de la planta, un proceso vertical que proporciona un mecanismo superior de control. Demostramos que los sistemas de vigilancia integrales de los procesos JAT/CTC están diseñados deliberadamente para establecer disciplina en la forma más eficiente y hacer posible un control minucioso con un mínimo de supervisores. El efecto deseado al enlazar estas fuerzas duales es minimizar las divergencias negativas del comportamiento esperado y de las normas administrativas definidas, mientras se identifican las divergencias positivas y se maximiza su potencial creativo